Painful Tumescent Liposuction Procedure - Is This Normal?

I had a lipo procedure done 2 days ago. It was tumescent/smartlipo/PAS. I was very nervous before the procedure but kept telling myself, the dread of something is always worse than going through....WELL, it wasn't. The first stage of him putting in the tumescent fluid was excruciatingly painful, I felt like I was on that table of torture and awake for every gory detail of it. He seemed to be very aggressive during this part. Is this normal to feel this kind of pain?

Doctor Answers 13

Local anesthesia during liposuction

There are many variables that might explain why some patients feel more pain than others during the anesthetic delivery prior to liposuction. If an area is being redone, if there was prior surgery there or trauma, then scar tissue has been built up and that is more painful to numb. If the anesthetic fluid is not buffered, the pH may be such that it can burn a little more. The local anesthetic is delivered by me very, very slowly which helps minimize the pain. Some medication can be given to help minimize the pain felt, but many times this is not even necessary with the above techniques. There are some patients whose pain threshold is so low that what isn't felt as painful by most people is excruciatingly painful to them. There may be a biochemical reason for this in how their neurologic pathways are constructed. The overwhelming majority of my patients do not feel that the anesthetic delivery is painful.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 36 reviews

Anesthesia for Liposuction

                                    Tumescent liposuction represents a significant advance in the management of localized fat collections. When this technique is utilized with local anesthesia alone the response varies from patient to patient.  The majority of patients appear to do well and have good results especially when smaller amounts of fat are removed.  Unfortunately, we frequently see patients who have had similar experiences and are less than happy with their procedure.

                  For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure.  When utilizing this approach, patients can have more fat removed and avoid multiple procedures.  The procedure is more comfortable and avoids break through pain which can occasionally occur with local anesthesia alone.

                  It’s important to realize that all surgical procedures and anesthetic techniques have risk.  This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized.  Most surgeons who perform tumescent liposuction agree that the anesthetic technique utilized is less important than the use of certified operating room and the presence of an anesthesiologist.  In other words you don’t want your surgeon to be your anesthesiologist. 

Proper meds for tumescent liposuction

Here is my recipe that has changed very little and been very successful for over ten years:

  • Lorazepam 1 mg the night before (keeps one from tossing and turning all night thinking about the next day's procedure.
  • Celebrex 400 mg one hour before the procedure.
  • Lorazepam 1-2 mg one hour before the procedure.
  • We start the procedure with a warmed bed, relaxing music, and whatever else might be calming to that person.
  • If there is anything more than minimal discomfort, we give Versed 5 mg. This is a pretty stong sedative and makes one drowsy for the rest of the day, but makes all the difference for the one out of ten who need it.

T. Wayne Day, MD
Nashville Dermatologic Surgeon
5.0 out of 5 stars 1 review

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Tumescent liposuction

Most painful part of liposuction is initial injection at the site of incision and initial part of infiltration particularly in the superficial plane. I prefer to go very slowly using very fine needle to minimize the pain. Starting with deep infiltration first, ensures good anaesthesia for superficial infiltration. Adding sodium bicarbonate to the solution reduces pain of the anaesthetic. Bottom line is surgeon needs to be very gentle and patient to minimize the discomfort.

Sanjay Parashar, MD
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Painful Tumescent Liposuction Procedure

There is pain associated with liposuction. I usually perform liposuction under general anesthesia or under local with IV sedation, so I will be able to take out as much fat as I can while making it a comfortable experience for the patient.

Kenneth Bermudez, MD
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Anesthesia and liposuction

Liposuction can be very painful; unfortunately, this is not advertised.  Some sort of medication must be given for it to be tolerated in most patients.  Oral valium and narcotics will work or IV sedation or general anesthesia.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
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Lipsuction and pain

Your experience sounds like you had liposuction under local anesthesia only.  This is one reason why I use sedation being performed by a board certified anesthesiologist.  I want my patients as comfortable as possible.  Then I can do my best work knowing that my patient is comfortable.

Steven Wallach, MD
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Liposcution is usually done under general anesthesia

Liposuction under local anesthesia is not for everyone.  Some patients are able to relax and get thru it while others are much better under general anesthesia.  The tumescent solution does have some of the numbing medication in it, but it is still uncomfortable for most unless asleep.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
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Local Anesthesia For Liposuction Is Not For Everyone

While many surgeons tout the advantages and ease of liposuction under local anesthesia, it is not for everyone. Your experience is not a rare one. This is why I prefer my patients to have general anesthesia or some form of sedation for most liposuction procedures. This is particularly important in a patient who has any form of anxiety about undering this type of operation.

Pain with tumescent liposuction is real (when you're awake).

Tumescent anesthesia was developed by a Dermatologist in order to allow liposuction without the need for general anesthesia. It is touted as being "better" because it avoids the (minimal) risk of general anesthesia, but what it really avoids for many non-surgeons who want to do cosmetic surgery was the need for surgical privileges at a hospital. Tumescent liposuction was and is a huge advance in improving results for liposuction patients, even if developed and popularized by a non-plastic surgeon.

Without inciting a "Turf battle" here, I will first say that tumescent liposuction is a procedure performed (properly) by physicians of several different specialties. These include plastic surgeons, but there are physicians of other specialty training that perform this procedure, including Dermatologists who call themselves "cosmetic surgeons" with varying degrees of surgical training, Dermatologic Surgeons with some surgical training, but not a full plastic surgical training program, and others, such as facial plastic surgeons, who sometime stray below the head and neck area, and even OB/GYN  or general surgeons with minimal plastic surgical training. Of course, there may be fully-trained plastic surgeons who may not have extensive cosmetic surgery experience with this procedure. What they do have is full surgical training in reconstructive and cosmetic surgery (including liposuction) of all parts of the body.

The key here is to check exactly what type of training your surgeon has had, where he or she operates, what type of hospital credentials (for which procedures) are granted, and expecially if they operate in their own office surgical facility, if their facility is AAAASF-accredited. If not, your "surgeon" may not be a real plastic surgeon. He or she may still be a wonderful liposuction expert, but you should know that injecting liters of tumescent local anesthesia into the fatty tissues of an awake patient is often quite painful, and that is why most board-certified (American Board of Plastic Surgery) plastic surgeons do their tumescent liposuction procedures under general anesthesia or at least intravenous sedation. Better sculpting can be performed, I believe, in a patient who is not flinching in pain from that occasional jab into an area that is not completely anesthetized by the tumescent fluid.

Regardless of the specialty or training of your surgeon, it seems as if your tumescent anesthesia was inadequate for good pain control during your operation. You avoided the cost and (negligible) risk of general anesthesia, but you suffered more discomfort than you anticipated. Hopefully your results will be what you expect. I am sorry you had this bad experience; it is truly not what the vast majority of liposuction patients encounter.

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.